Individual
JACKIE M COLAIZY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1900 SILVER LAKE ROAD NW, SUITE 110, NEW BRIGHTON, MN 55112
(651) 628-9566
(651) 628-0411
Mailing address
1900 SILVER LAKE ROAD NW, SUITE 110, NEW BRIGHTON, MN 55112
(651) 379-1718
(651) 379-1738
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1727
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320477400
—
MN
Enumeration date
03/30/2006
Last updated
04/13/2016
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